Neuroradiology

Approach to Head CT

Rapid Assessment of CT head or Do I need to call a Neurosurgeon

NOW!!!1. Is the brain in the middle of the head?

2. Do the 2 sides of the brain look alike?

3. Can I see the smile and the pentagon?

4. Is the 4th ventricle in the midline and symmetrical?

5. Are the lateral ventricles huge with effaced sulci?• + the Anderson additional questions

6. Are there any abnormal white things inside the skull?

7. Are there any abnormal black things inside the skull?

1 – 5 From Brant & Helms “Fundamentals of Diagnostic Radiology” 2nd ed.

Is the brain in the middle of the head?

YES NO

Do the 2 sides of the brain look alike?

YES NO

The Smile• Quadrigeminal Plate Cistern

The Pentagon (or star)• Suprasellar Cistern

No Smile, No Pentagon

No Good!!

4th Ventricle

4th Ventricle

Are the lateral ventricles huge with effaced sulci?

Ventriculomegaly

2 different 30ish year old patients